Airway Stenting

Introduction

If you or someone close to you has been told that an airway has become narrowed or blocked, breathing can quickly turn from something automatic into something exhausting. Walking across a room, lying flat to sleep, or speaking in full sentences may feel like hard work. Airway stenting is one of the procedures doctors use to restore airflow in this situation.

This guide is written for patients who have already been diagnosed with a condition that may need airway stenting — such as a tumour pressing on the windpipe, scarring after a long stay on a ventilator, or a collapsing airway — and who are now preparing for the procedure or weighing it as an option. It explains what airway stenting is, why it is done, what to expect during and after the procedure, and the longer-term care that comes with living with a stent.

The choice of whether airway stenting is appropriate, and which type of stent to use, is always made by an interventional pulmonologist who has reviewed your specific scans, breathing tests, and overall health. This article is intended to help you have a more informed conversation with that team.

What Is Airway Stenting?

Airway stenting is a procedure in which a small tubular device, called a stent, is placed inside a narrowed or blocked airway to keep it open. The airways are the tubes that carry air from the nose and mouth down into the lungs. The main airway is the trachea (windpipe), which divides into two large branches called the main bronchi, one going to each lung. These then divide into smaller branches.

When part of this tubing becomes narrowed — whether by a tumour, scar tissue, or collapse of the cartilage that normally holds it open — air cannot flow freely. A stent acts like an internal scaffold. Once placed, it holds the airway open from the inside, allowing air to pass through again.

The procedure is performed by an interventional pulmonologist, a lung specialist with additional training in advanced airway procedures, using a bronchoscope — a thin tube with a camera and working channel that is passed through the mouth or nose into the airway.

Types of Airway Stents

Several types of stents are used in modern interventional pulmonology. The choice depends on where the narrowing is, what is causing it, and whether the stent is expected to stay in place permanently or only for a period.

• Silicone stents. Made of medical-grade silicone. They are usually placed using a rigid bronchoscope under general anaesthesia. They can be repositioned or removed relatively easily, which makes them useful for benign (non-cancer) narrowing where the stent may not be needed forever.
• Self-expanding metallic stents (SEMS). Made of a fine metal mesh, often nitinol. They can be deployed through a flexible bronchoscope and expand to fit the airway. Some are covered with a thin membrane to prevent tumour or tissue growing through the mesh; others are uncovered. Covered metallic stents are commonly used for malignant (cancer-related) obstruction.
• Hybrid stents. Combine features of silicone and metallic stents to balance stability, ease of placement, and removability.
• Y-stents. Y-shaped stents are designed for the area where the trachea splits into the two main bronchi (the carina). They have one limb sitting in the trachea and two in the bronchi.
• 3D-printed and patient-specific stents. In some centres, stents can be custom-made to fit unusual airway shapes. Availability varies.

Major interventional pulmonology societies, including the American College of Chest Physicians (CHEST) and the European Respiratory Society, recognise that there is no single “best” stent for every situation. The choice is individualised.

Why Is Airway Stenting Performed?

Airway stenting is performed when an airway becomes narrowed enough to interfere with breathing, and when other treatments cannot quickly or fully reopen it. Doctors broadly group the causes into malignant (cancer-related) and benign (non-cancer) conditions.

Malignant (Cancer-Related) Causes

• Lung cancer growing into or pressing on the trachea or main bronchi
• Oesophageal cancer or thyroid cancer compressing the airway from outside
• Enlarged cancerous lymph nodes in the chest
• Metastatic tumours (cancer that has spread from another organ) involving the airway
• Tracheoesophageal fistulas — abnormal openings between the airway and the food pipe, often caused by cancer or its treatment

In these settings, stenting is often used to relieve breathlessness quickly while other treatments such as chemotherapy, radiotherapy, or targeted therapy address the underlying cancer.

Benign (Non-Cancer) Causes

• Post-intubation or post-tracheostomy stenosis — scarring of the airway after a prolonged period on a breathing tube
• Tracheomalacia and bronchomalacia — weakness of the cartilage that normally keeps the airway open, causing it to collapse during breathing
• Tuberculosis-related airway scarring, which is a common cause of benign narrowing in many parts of the world, including India
• Inflammatory conditions such as relapsing polychondritis or granulomatosis with polyangiitis
• Airway anastomotic complications after lung transplantation, including narrowing at the surgical join
• Trauma to the airway

For benign conditions, stenting is sometimes used as a temporary bridge while the underlying problem is treated, or while a patient is prepared for definitive surgery.

Who Is a Candidate?

Not every narrowed airway needs a stent. Whether stenting is appropriate depends on several factors that your interventional pulmonologist will assess. These typically include:

• Location of the narrowing. Stents work best in the central airways — the trachea and main bronchi. Narrowing very high in the airway (close to the voice box) or deep in smaller branches may not be suitable for stenting.
• Degree of obstruction. A stent is more likely to be considered when the airway is significantly narrowed and symptoms are severe.
• Underlying cause. Whether the narrowing is from a tumour, scar tissue, external compression, or collapse changes the type of stent and the overall plan.
• Whether the airway wall is open enough to accept a stent. If the airway is completely blocked, doctors often need to first reopen it using laser, electrocautery, cryotherapy, or mechanical debulking before placing a stent.
• Overall health and life expectancy. In cancer patients, stenting is often considered when it can meaningfully improve quality of life and allow further treatment.
• Availability of alternatives. If the airway can be reopened without a stent — for example, by treating the tumour with radiotherapy or by surgical resection of a short stricture — that may be preferred.

Major societies, including CHEST and the American Thoracic Society, emphasise that stenting in benign disease should generally be reserved for situations where other options have been considered, because long-term stents can cause their own problems.

Alternatives to Airway Stenting

Airway stenting is one tool among several. Depending on the cause and severity of the narrowing, doctors may consider:

• Balloon dilation. A balloon is inflated inside the narrowed segment to stretch it open. This can work well for short, web-like strictures and may be repeated.
• Endobronchial laser, electrocautery, or argon plasma coagulation. These techniques use heat to remove tumour tissue blocking the airway.
• Cryotherapy. Uses extreme cold to destroy tumour tissue or remove debris.
• Photodynamic therapy and brachytherapy. Specialised cancer treatments delivered through the bronchoscope.
• Surgical resection. For some benign strictures and selected cancers, surgical removal of the affected segment and reconnection of the airway (tracheal or bronchial resection) is the definitive treatment.
• External-beam radiotherapy and systemic therapy. For tumour-related narrowing, shrinking the tumour with radiation or drug therapy may relieve obstruction over time.
• Non-invasive ventilation (CPAP or BiPAP). In some cases of dynamic airway collapse, positive-pressure support during breathing can help.

Often, several of these are combined. For example, a tumour blocking the trachea might first be debulked using laser, then a stent placed to keep the cleared segment open while radiotherapy is given.

Preparing for Airway Stenting

The work-up before airway stenting helps the team plan the safest and most effective procedure. It typically includes the following steps.

Imaging

A CT scan of the chest is almost always performed. Modern CT scanners can produce three-dimensional reconstructions of the airway, helping the team measure the length and diameter of the narrowing and decide on stent size. Sometimes a virtual bronchoscopy reconstruction is created from the CT data.

Bronchoscopy

A diagnostic bronchoscopy may be done before stenting to directly inspect the airway, take biopsies if needed, and confirm the location and nature of the obstruction.

Breathing and Oxygen Tests

• Pulmonary function tests (PFTs), including spirometry, measure how much air you can move and how quickly.
• Oxygen saturation is measured using a small clip on the finger.
• Arterial blood gas analysis may be used if oxygen or carbon dioxide levels are a concern.

Anaesthesia and Medical Review

Because most airway stenting procedures are done under sedation or general anaesthesia, an anaesthetist will review your medical history, medications, and any prior reactions to anaesthesia. You will usually be asked to:

• Fast (no food or drink) for several hours before the procedure
• Stop or adjust blood-thinning medications under medical guidance
• Continue most other regular medications with sips of water, as advised
• Inform the team about allergies, dental problems, and loose teeth (relevant if a rigid bronchoscope is used)

If you smoke, stopping before the procedure — even briefly — can help reduce coughing and complications. The longer the period of stopping, the better.

What Happens During Airway Stenting

Airway stenting is performed in a specialised bronchoscopy suite or an operating theatre with full anaesthetic and resuscitation support. The exact technique depends on the type of stent being placed.

Anaesthesia and Airway Access

Most patients receive either deep sedation or general anaesthesia. The bronchoscope is passed through the mouth or nose. For silicone stents, a rigid bronchoscope (a straight metal tube) is generally used; for self-expanding metallic stents, a flexible bronchoscope is often sufficient.

Clearing the Airway

If a tumour or thick scar is partly blocking the airway, the doctor may first clear a channel using laser, electrocautery, cryotherapy, or mechanical removal. Sometimes balloon dilation is used to gently stretch a narrowed segment.

Stent Placement

• Self-expanding metallic stents are loaded inside a delivery catheter in a compressed form. The catheter is passed to the right spot, and the stent is released. It expands to its full size, anchoring itself against the airway wall.
• Silicone stents are loaded into a special applicator and pushed into position through the rigid bronchoscope. The doctor may then use forceps to fine-tune the position.
• Y-stents are positioned carefully so the limbs sit in the correct branches.

Once placed, the stent’s position is checked visually with the bronchoscope, and sometimes confirmed with fluoroscopy (real-time X-ray).

Duration

The procedure usually takes between 30 minutes and 2 hours, depending on complexity. Some patients are extubated (the breathing tube removed) in the procedure room; others go briefly to a recovery area or intensive care for observation.

Recovery and Healing

Recovery from airway stenting depends mainly on the underlying disease, the type of stent, and how the patient was breathing before the procedure.

The First Few Hours

Hospital Stay

The hospital stay typically ranges from one to several days, depending on the underlying condition and recovery. Patients with advanced lung cancer or significant breathing problems may need a longer stay, sometimes including time in an intensive care unit.

The First Few Weeks

• Coughing is common as the body adjusts to the stent. It usually settles over days to weeks.
• Mucus may build up around the stent because the normal clearance of the airway is disturbed. Doctors often prescribe mucolytic medications and nebulised saline to help.
• Voice changes can occur if the stent is high in the trachea.
• Breathing exercises and chest physiotherapy may be advised.

Follow-up Bronchoscopy

Many interventional pulmonologists schedule a follow-up bronchoscopy a few weeks after stent placement, and again at intervals afterwards, to:

• Check that the stent is in the correct position
• Clean any thick mucus or crusts
• Look for tissue growing into or around the stent
• Decide whether the stent should remain, be repositioned, or be removed

Risks and Complications

Airway stenting can dramatically improve breathing, but like all interventional procedures it carries risks. Patients and families benefit from understanding these in advance.

Early Complications

• Bleeding from the airway, particularly when a tumour is debulked
• Airway irritation, coughing, and throat soreness
• Anaesthetic complications, such as reactions to medications
• Stent malposition requiring repositioning
• Airway perforation — rare but serious

Later Complications

• Mucus plugging. Thickened mucus can collect inside the stent and block it. This is one of the most common longer-term issues.
• Stent migration. The stent may shift from its original position, especially if the underlying disease changes (for example, a tumour shrinks with chemotherapy).
• Granulation tissue formation. The body may respond to the stent by forming bumpy scar-like tissue at its edges, which can itself narrow the airway.
• Tumour ingrowth or overgrowth. With uncovered metallic stents, cancer tissue can grow through the mesh; with any stent, tumour can grow beyond the ends.
• Infection. Bacterial colonisation around the stent can contribute to recurrent chest infections.
• Stent fracture. Metallic stents can occasionally break over time.

When to Seek Urgent Care

After airway stenting, you should seek urgent medical attention if you experience:

• Sudden worsening of breathlessness or noisy breathing
• Coughing up significant amounts of blood
• High fever or shaking chills
• Severe chest pain
• Sudden change in voice or inability to clear secretions

These can sometimes indicate stent migration, blockage, infection, or other problems that need prompt evaluation.

Life After Airway Stenting

Most patients adapt well to living with an airway stent. There are some practical points that make day-to-day life smoother and reduce the risk of complications.

Keeping the Stent Clear

• Drinking enough fluids, unless restricted for another reason
• Using nebulised saline regularly to humidify the airway
• Mucolytic medications, when prescribed
• Gentle, regular movement and breathing exercises

Avoiding Smoke and Pollution

Tobacco smoke, cooking smoke, and heavy air pollution irritate the airway and worsen mucus production. Stopping smoking is one of the most important steps for anyone with a stent, regardless of the underlying cause. Family members who smoke are encouraged to do so away from the patient.

Infections and Vaccinations

Patients with airway stents are at increased risk of chest infections. Vaccinations against influenza, pneumococcus, and other respiratory infections are commonly recommended, in line with general advice for people with chronic lung conditions.

Carrying Information About the Stent

It is helpful to carry a card or written record that says you have an airway stent, including the type, size, and date of placement. In an emergency, this information helps any treating team avoid unsafe interventions — for example, certain types of airway suctioning or imaging.

Returning to Daily Activities

Many patients are able to return to walking, light work, and normal social activities once the early recovery period is over. The pace depends heavily on the underlying disease. In cancer-related stenting, the focus is often on relief of symptoms and being able to take part in further cancer treatment. In benign disease, longer-term return to full activity is sometimes possible.

Long-term Outlook

The outlook after airway stenting depends much more on the underlying cause than on the stent itself.

• In cancer-related obstruction, stenting can significantly improve breathing and quality of life, allowing patients to continue or begin treatments such as chemotherapy or radiotherapy. Overall prognosis is determined by the cancer itself.
• In benign airway disease, some patients keep a stent for many years; others use it as a temporary bridge until surgery or further procedures resolve the underlying problem. Patients with tracheomalacia, post-intubation stenosis, or post-transplant strictures often need ongoing review.
• Regular follow-up with the interventional pulmonology team is essential. Most teams schedule a structured follow-up plan including bronchoscopy at intervals.

Survival numbers and outcomes vary widely between patients and conditions, and personalised estimates should come from your treating doctor based on your scans, biopsies, and overall health.

Airway Stenting in Children

Airway stenting in children is far less common than in adults and is performed only in specialised paediatric centres. The reasons for considering stenting are different and include:

• Severe tracheomalacia or bronchomalacia not controlled by non-invasive support
• Congenital airway narrowing
• Airway compression from vascular rings or other vascular abnormalities
• Post-surgical airway narrowing, including after repair of congenital heart disease

Decisions are made by multidisciplinary teams involving paediatric pulmonologists, paediatric ENT specialists, cardiothoracic surgeons, and paediatric anaesthetists. Because children’s airways grow, the long-term plan must take growth into account. Some stents are designed to be removed once the airway has matured or has been surgically corrected.

Major paediatric airway societies emphasise that stenting in children should be reserved for carefully selected cases, and that alternatives such as airway surgery, positive-pressure support, or watchful waiting are usually considered first.

Frequently Asked Questions

Is airway stenting painful?

The procedure itself is performed under sedation or general anaesthesia, so you do not feel pain during placement. Afterwards, sore throat, hoarseness, and coughing are common but usually mild and short-lived. Persistent pain is not expected and should be reported to your doctor.

Will I be able to feel the stent inside my airway?

Most patients do not feel the stent once they have adjusted to it. In the first days and weeks, some people are aware of mild discomfort or a feeling of something in the airway, and may cough more than usual. This typically settles as the body adapts.

Is airway stenting permanent?

It depends on the type of stent and the underlying disease. Some stents are designed to be removable, particularly silicone stents used in benign conditions. Others, especially uncovered metallic stents placed for advanced cancer, are generally meant to remain in place. The plan for your specific stent should be discussed with your interventional pulmonologist.

Can a stent be removed or replaced later?

Many stents, especially silicone stents and covered metallic stents, can be removed or repositioned during a follow-up bronchoscopy if needed. Removal becomes more complex when tissue has grown through or around the stent, but experienced teams have several techniques to manage this.

How long does an airway stent last?

There is no fixed lifespan. Some stents function well for many years, while others need to be revised or replaced earlier because of mucus plugging, migration, granulation tissue, or changes in the underlying disease. Regular follow-up helps detect issues early.

Can I travel by air with an airway stent?

Many patients with stable stents do travel, including by air, but this is an individual decision. Factors include your oxygen levels at altitude, the underlying condition, and how recently the stent was placed. Your pulmonologist can advise on travel safety and whether in-flight oxygen is needed.

Will I still need other treatments after stenting?

Yes, in most cases. The stent treats the mechanical narrowing but not the underlying cause. Cancer-related stenting is usually combined with chemotherapy, radiotherapy, or other cancer-directed treatment. Benign disease may still need inhalers, antibiotics for infections, or surgery. Stenting is part of a broader plan, not a standalone cure.

Who performs airway stenting?

Airway stenting is performed by an interventional pulmonologist — a lung specialist who has completed additional training in advanced bronchoscopy and airway procedures. In some centres, thoracic surgeons with airway training also perform these procedures. When choosing a team, it is reasonable to look for relevant qualifications, experience with the specific type of stent, and a centre that routinely manages complex airway disease.

Conclusion

Airway stenting is a specialised interventional procedure that can restore breathing in patients whose airways have become narrowed or blocked by cancer, scarring, collapse, or external compression. For many patients, it brings rapid relief of frightening breathlessness and makes it possible to continue treatment of the underlying disease and to return to meaningful daily activity.

The decision to place a stent — and the choice between silicone, metallic, hybrid, or Y-stents — depends on the specific cause, location, and severity of the narrowing, as well as your overall health and goals of care. Understanding what the procedure involves, what recovery looks like, and how life with a stent is managed can make this part of the journey less overwhelming and support a fuller conversation with your interventional pulmonology team.